title: Small bowel obstruction after hand-assisted laparoscopic sigmoid colectomy for cancer.
abstract: Hand-assisted laparoscopic surgery (HALS) was introduced as a bridge towards totally laparoscopic procedures. Some concerns are raised regarding its long-term complications such as incisional hernia and adhesive small bowel obstruction. A woman was admitted with colicky central abdominal pain, distension and vomiting. She had a hand-assisted laparoscopic sigmoid colectomy for cancer 6 years earlier. Clinical examination revealed a well-healed periumbilical scar with no evidence of incisional hernia. The abdomen was distended with exaggerated bowel sounds. A CT scan showed dilated loops of small bowel with a transitional zone and distally collapsed bowel. A diagnostic laparoscopy revealed a twisted segment of small bowel that was adherent to the anterior abdominal wall at the hand-port closure site. This segment was released laparoscopically without the need for a resection. Adhesive small bowel obstruction to the hand-port site closure may occur years after HALS and can simply be relieved by laparoscopic exploration.
authors.affiliation: Department of Surgery, King Fahad Specialist Hospital, Dammam, Eastern Province, Saudi Arabia.
authors.forename: Abdul-Wahed
authors.initials: AW
authors.lastname: Meshikhes
mesh_terms: D000328:Adult; D003082:Colectomy / Q000009:adverse effects*; D012809:Colon, Sigmoid / Q000601:surgery*; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D058733:Hand-Assisted Laparoscopy / Q000009:adverse effects*; D006801:Humans; D007415:Intestinal Obstruction / Q000175:diagnosis / Q000209:etiology*; D007421:Intestine, Small; D011183:Postoperative Complications; D012811:Sigmoid Neoplasms / Q000601:surgery*; D014057:Tomography, X-Ray Computed